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对于DAWN和DEFUSE-3不合格的急性缺血性中风患者的内血管血栓切除术:系统性审查和元分析
Samah Morsi1, Sherief Ghozy2,3, Mohamed Elfil4
1Department of Radiology, Mayo Clinic Rochester, Rochester, MN, USA. doc.samah92@gmail.com.
Journal of neurology
|February 2, 2024
概括
对于急性缺血性中风 (AIS) 的内血管治疗 (EVT) 显示出类似的功能独立性,无论患者是否符合DAWN/DEFUSE-3标准. 然而,不符合条件的患者的并发症率更高,这表明在扩大EVT使用时要谨慎.
科学领域:
- 神经学 神经学
- 干预性放射学 干预性放射学
- 脑卒中医学 脑卒中医学
背景情况:
- 内血管治疗 (EVT) 是有效的急性缺血性中风 (AIS) 与大血管封闭 (LVO).
- 黎明和DEFUSE-3试验将EVT治疗窗口延长到6-24小时.
- 调查这些试验标准之外的患者的EVT结果至关重要.
研究的目的:
- 为了比较AIS患者晚窗前循环LVO的EVT结果.
- 分析DAWN/DEFUSE-3合格 (DD) 和不合格 (NDND) 组之间的差异.
主要方法:
- 对晚期窗口前部循环LVO (>6h) 的EVT结果的系统审查和元分析.
- 将患者分为DAWN/DEFUSE-3符合条件 (DD) 和不符合条件 (NDND) 的组.
- 对9项研究的分析,重点关注基线特征,再输,功能独立性,症状性内出血 (sICH) 和死亡率.
主要成果:
- 在DD和NDND组之间,成功的再输血率 (TICI 2b-3) 在DD和NDND组之间是相似的 (OR=0.86).
- 90天后的功能独立性 (mRS 0-2) 是可比的 (OR=1.12).
- NDND患者的远端闭塞,SICH (OR=0.49对DD) 和90天死亡率 (OR=0.55对DD) 的比率更高.
结论:
- 对于DD和NDND患者来说,EVT提供了相当的功能独立性.
- 在NDND患者中较高的并发症率 (SICH,死亡率) 需要谨慎考虑扩大EVT资格.
- 需要进一步的研究来确定可能受益于EVT的特定NDND患者亚组.
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